The LPN is working for a physician who participates in an HMO and will be assisting with the billing. What type of information regarding capitation does the nurse need to understand?
A) Fees are not based on the number of services provided but rather are projected to the number of participants and expected services.
B) Fees are based on the number of services that the primary care provider bills for.
C) The HMO makes money based on the degree of illness and number of diagnostic tests that are done.
D) The fees that are charged are different even with the same diagnosis.
A
Feedback:
With an HMO, the fee is not based on the number of services provided but rather is projected to the number of participants and expected services. This type of financial management is referred to as capitation, which refers to the actual head or person count. Option A is incorrect because HMO is based on the number of participants and expected services. The HMO makes money by keeping people healthy and out of the hospital. The fees are the same regardless of the actual service or frequency of care provided.
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